Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children:a longitudinal, retrospective, population-based cohort study

BACKGROUND: This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances. METHODS: Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances. RESULTS: The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01–4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99–7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29–10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49–4.66, p < 0.001) than those from better home circumstances. CONCLUSIONS: Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes

Echinocandin resistance due to simultaneous FKS mutation and increased cell wall chitin in a Candida albicans bloodstream isolate following brief exposure to caspofungin

Echinocandins are first-line agents for treating severe invasive candidiasis. Glucan synthase gene (FKS1) mutations lead to echinocandin resistance but the role of enhanced chitin expression is not well recognized in clinical isolates. We report a case of bloodstream Candida albicans infection with both Fks1 hotspot mutation and elevated cell wall chitin

Update on the eradication of 'Helicobacter pylori' infection in adult and pediatric patients from the northern region of Pakistan

'Helicobacter pylori' infection is associated with different gastric diseases, notably gastric cancer. The present study is aimed at comparing the effectiveness of various 'H. pylori' eradication regimens among adult and pediatric patients. A total of 3178 (396 children) patients were recruited. 'H. pylori' infection was diagnosed by nuclear stable isotopic 13C urea breath test (UBT) and positive patients were randomly allocated first-line eradication regimens. The second or third-line regimens were assigned to those who had failed first-line treatment. A negative UBT at least 4 weeks after the completion of treatment indicated a successful eradication of 'H. pylori'. Eradication rates (ER) by per-protocol (PP) and intention-to-treat (ITT) analysis were recorded. The overall prevalence of 'H. pylori' infection was 61.2% and slightly higher in males as compared to females. The modified concomitant therapy showed higher PP (77.8%) and ITT (72.7%) ER as first-line treatment. Among second-line therapies, PP/ITT ER of 63.6% / 55.3% were observed for quadruple therapy in adults. Standard triple therapy with probiotic and modified concomitant therapy as first-line and quadruple therapy as a second line thus is the choice for 'H. pylori' eradication in adult gastric disease patients. In pediatric patients, standard triple therapy was more effective as a first-line with about 68.8% ER.Eine 'Helicobacter pylori'-Infection ist mit verschiedenen gastrischen Krankheiten assoziiert, insbesondere Magenkrebs. Diese Studie vergleicht die Effizienz verschiedener 'H. pylori'-Ausrottungs-Methoden bei erwachsenen Patienten und Kindern. Insgesamt wurden 3178 (396 Kinder) Patienten rekrutiert. Eine 'H. pylori'-Infection wurde mittels 13C-Harnstoff-Atemtest (UBT) diagnostiziert, und positive Patienten wurden nach dem Zufallsprinzip verschiedenen "first-line" Behandlungsverfahren zugeordnet. "Second" oder "third-line"-Behandlungen erhielten diejenigen, bei denen die erste Behandlung nicht erfolgreich war. Ein negativer UBT mindestens 4 Wochen nach der Beendigung der Behandlung indizierte die erfolgreiche Vernichtung von 'H. pylori'. Ausrottungsraten (ER) durch "per-protocol (PP)" und "intention-to-treat (ITT)"-Analysen wurden erfasst. Mit 61.2% waren etwas mehr Männer als Frauen infiziert. Die "modified concomitant"-Therapie zeigte höhere PP (77.8%) und ITT (72.7%) ER als erste Behandlung. Bei den "second-line"-Therapien wurden PP/ITT ER von 63.6% / 55.3% für die "quadruple"-Therapie in Erwachsenen beobachtet. Die "standard triple"-Therapie mit Probiotic und die "modified concomitant"-Therapie als "first" und die "quadruple"-Therapie als "second-line" ist daher die Wahl für eine 'H. pylori'-Vernichtung in erwachsenen Patienten mit gastrischen Krankheiten. In Kindern war die "standard triple"-Therapie effizienter als "first-line"-Behandlung mit ~68.8% ER

Validity of the +1.50 plus lens screening test as a predictor of uncorrected moderate hyperopia

Purpose: Screening for uncorrected hyperopia in school children is important given its association with poorer visual function and academic performance. However, standard distance visual acuity screening may not detect low to moderate hyperopia. The plus lens test is used to screen for hyperopia in many school screening protocols, but has not been well validated. The current study investigated the effectiveness of the plus lens test to identify hyperopia in school children. Methods: Participants included Grade 2 school children. Monocular distance visual acuity (logMAR letter chart) was measured unaided, and then through a +1.50D lens, known as the plus lens test. Cycloplegic refraction was undertaken to classify moderate hyperopia (≥+2.00D). Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for commonly used cut-offs for the plus lens test: 6/6, 6/9 and less than two lines difference between unaided acuity and acuity through the plus lens test. Results: The sample included 59 children (mean age 7.2 ± 0.4 years). Fourteen (24%) children were classified as having uncorrected hyperopia. The sensitivity and specificity of the +1.50 plus lens test for identifying hyperopia were 0% and 98% respectively for a 6/6 cut-off, 29% and 91% for 6/9 cut-off, and 50% and 76% for a <2 line reduction between unaided acuity and acuity through the plus lens test. Receiver Operating Curve (ROC) analysis revealed area under curves of 0.69 based on acuity through the plus lens test, and 0.65 for a reduction in acuity through the plus lens test. Conclusions: The plus lens test has low sensitivity for detecting uncorrected hyperopia using traditional cut-offs of 6/9 or better. This raises questions about the role of the plus lens test in school screening batteries.</p